A 24 y/o male was brought to psychiatry emergency. He appeared very excited, and was wearing orange t shi and pink pants along with googles. On seeing the doctor he said- ‘I am the ultimate doctor, i have done MD and MS in all the specialities and I can cure all the diseases’. The family members repoed that he has not slept in last two days and was saying that he is trying to find the magic formula to reach moon in one hour. What is the drug of choice in this patient?

## **Core Concept**
The patient's presentation suggests a manic episode, characterized by elevated mood, decreased need for sleep, grandiosity, and excessive involvement in pleasurable activities. This condition is commonly seen in Bipolar Disorder. The treatment for acute mania involves mood stabilizers or antipsychotics.

## **Why the Correct Answer is Right**
The correct answer, **Olanzapine**, is an atypical antipsychotic that is effective in treating acute mania. It has a broad pharmacological profile, acting on dopamine (D2, D3, D4), serotonin (5-HT2A, 5-HT2C, 5-HT6), and muscarinic receptors, which helps in stabilizing mood and reducing symptoms of mania. Olanzapine has a rapid onset of action, making it suitable for acute management.

## **Why Each Wrong Option is Incorrect**
- **Option A:** Lithium is a mood stabilizer used in the treatment of bipolar disorder but might not be the first choice in acute mania due to its slower onset of action and potential side effects.
- **Option B:** Valproate is another mood stabilizer effective in treating mania but might not be as quickly effective as antipsychotics like olanzapine in acute settings.
- **Option D:** Risperidone is an atypical antipsychotic that can be used in treating mania; however, olanzapine might have a slightly different side effect profile and efficacy that could make it preferable in certain cases.

## **Clinical Pearl / High-Yield Fact**
In the acute management of mania, especially in emergency settings, atypical antipsychotics like olanzapine are often preferred due to their rapid onset of action. It's crucial to monitor for side effects such as weight gain and metabolic changes.

## **Correct Answer:** . **Olanzapine**

✓ Correct Answer: C. Risperidone